Background: Macroencapsulation is a strategy to protect transplanted islets from rejection and autoimmune attack. This study addresses questions about the survival and function of macroencapsulated syngeneic islets.
Methods: Planar immunobarrier membrane diffusion devices were used for syngeneic islet transplantation. After being mixed with a 1% alginate solution, a total of 250, 500, 750 or 1000 islets were loaded into the devices, which were implanted into the epididymal fat pad(s) of streptozocin diabetic mice.
Results: The success rate for restoration of normoglycemia at week 4 was highest for the recipients receiving two devices, each with 500 islets. Loading 750 or 1000 islets provided no improvement over loading 500 islets in a single device. Devices containing 250 islets were rarely successful. There was a striking tendency of transplants to either bring glucose levels into the near normal range or to fail with marked hyperglycemia. After an overnight fast at 1 and 4 weeks, but not at 12 weeks, hypoglycemia was found. The insulin content of devices from animals with normalized glucose values was higher than the insulin content in failed devices. Islet volume was maintained for 12 weeks, and fibrosis did not increase.
Conclusions: A relatively small mass of macroencapsulated islet tissue can survive and function well enough to normalize glucose levels for at least 12 weeks. Maintenance of glucose levels in the near-normal range seems to have a beneficial influence on graft success. The finding of fasting hypoglycemia raises important clinical questions about islet dysfunction. Important limitations in the requirements for islet packing density in macroencapsulation have been defined. New approaches for improving islet packing density must be developed to make diffusion-dependent macroencapsulation more practical.